Fainting, High HCT, Low Ferritin — TRT Vet of 10+ Years Needs Help ASAP

Hey guys,
I’ve been on 100mg Test Cyp IM weekly for the past 10 years with good results overall, but something’s changed recently and I need experienced eyes on this.

For the past month, I’ve had constant lightheadedness, faint feelings, brain fog, and general weakness — especially in the mornings. It’s persistent and exhausting. The only thing that gives temporary relief is 0.5–1mg Xanax, which tells me it might be calming something neurologic or adrenal, but it’s not a real solution.

:syringe: TRT & Hormone Panel:

  • Total T: 634
  • SHBG: 24.3
  • Free T (calc): 162.7
  • Estradiol: 65 pg/mL

:drop_of_blood: CBC Trends:

  • 4/3/25 – RBC: 6.11 / HGB: 18.8 / HCT: 55.9
  • 4/10/25 – RBC: 5.71 / HGB: 17.8 / HCT: 52.4
  • 4/28/25 – RBC: 5.80 / HGB: 18.0 / HCT: 53.7

:nut_and_bolt: Iron Panel:

  • Iron: 132 (50–180)
  • TIBC: 390 (250–425)
  • Saturation: 34%
  • Ferritin: 23 (Ref: 38–380) ← :warning: Very concerned about this

:receipt: Additional Info:

  • Omeprazole 40mg daily for 10+ years (likely impacting iron absorption)
  • Diagnosed mild sleep apnea (on CPAP since Jan 2024)
  • Went to ER twice recently with near-syncope; both times told it’s just low potassium and dehydration (which I’m now addressing)
  • Current PCP says: my symptoms are from elevated HCT/HGB and is pushing me to donate a unit of blood
  • She also wants to cut my Test to every 2 weeks and start an AI, which I know from this forum is not best practice

:red_question_mark:My Main Questions:

  • Have any of you had symptoms like mine (faintness, dizziness, visual pressure) with elevated HCT or low ferritin?
  • Would you donate blood with ferritin at 23?
  • Should I be concerned about Estradiol at 65, or just leave it alone?
  • Is there any chance this is more ferritin-related than HCT-related?
  • Could long-term omeprazole be contributing to the problem?
  • What labs or fixes would you suggest next?

I really value this community’s knowledge. I’m looking for clarity and a solid path forward from people who’ve walked this road. Appreciate any and all input.

Yummy

Why e2w? Just lower dose a smidge… Donate blood and lower to 75mg/wk for a little bit until you are stable… there is some validity to the AI… how are you feeling?

Don’t be, testosterone induced erythropoiesis… at least initially… will lower Ferratin as iron is used up to create more red blood cells

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Could it hurt to supplement with iron?

I would not donate.
E2 is fine unless you have symptoms .

Ferritin is like the canary in the coal mine and can be a lead initiator for declining iron storage.

Get tested again in a few weeks and see if the iron is still low normal or has dropped to low. If you continue to decline it might be time for a stool sample, as you might be losing blood in the stool.

Any chance you have ulcers?